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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastroparesis diabeticorum is a common complication that develops in patients with diabetes mellitus. Although the pathogenesis remains unclear, the clinical symptoms of nausea, vomiting, and gastric dilatation frequently respond to metoclopramide hydrochloride, an agent that stimulates gastric emptying in addition to acting centrally as an antiemetic. Occasionally, patients are encountered whose severe gastroparesis is unresponsive to oral metoclopramide and who require intravenous therapy or drainage procedures (eg, pyloroplasty or gastrojejunostomy). Rectal administration of metoclopramide successfully controlled the clinical symptoms of gastroparesis diabeticorum in an outpatient after failure of oral dosing, thus avoiding the need for intravenous therapy. Gastric emptying studies and serum metoclopramide levels following a 25-mg rectal dose of metoclopramide hydrochloride verified the efficacy of therapy.
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PMID:Metoclopramide suppositories in the treatment of diabetic gastroparesis. 377 59

Symptoms suggesting gastroparesis in patients without gastric outlet obstruction are very common but their relation to an objective delay of gastric emptying has been poorly investigated. A dual isotopic technique was used to evaluate patients with non-obstructive dyspepsia (idiopathic and secondary) (part 1) and to assess the effects of a new gastrokinetic agent: cisapride, on gastric emptying in such patients (part 2). Sixty patients with postprandial dyspeptic symptoms (vomiting, nausea, gastric bloating or full feeling) and without lesions at upper endoscopy were studied. They were distributed into three groups: idiopathic dyspepsia (n = 31), postvagotomy dyspepsia (n = 16) and dyspepsia secondary to medical disorders (n = 13). All patients ingested the same ordinary meal; 99mTc sulphur colloid tagged egg white was the solid phase marker and 111In chloride was the liquid phase marker. In part 1, evaluation of gastric emptying in the first 50 patients shows a delay of gastric emptying rate of solids and liquids as compared with controls. Striking differences separate the three groups of patients, however, percentages of delayed gastric emptying rate of solids and or liquids averaged 90% in postvagotomy or secondary dyspepsia groups whereas it was 44% in idiopathic dyspepsia group. Moreover, liquid emptying rate was often the only one impaired in idiopathic dyspepsia, and in 12 of the 27 patients of this group the faster emptying rate of liquids as compared with that of solids (always found in normal subjects), could not be evidenced. In part 2, 10 patients entered a double blind cross over study of cisapride (8 mg intravenously). A significant increase of solid (p<0.01) and liquid (p<0.05) emptying rates was found in patients with initial gastric emptying delay. This study emphasises the importance of an objective evaluation of gastric emptying in the presence of symptoms of gastric stasis and suggests that specific local acting therapy may be useful in patients with identified abnormal gastric emptying.
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PMID:Measurement of gastric emptying in dyspeptic patients: effect of a new gastrokinetic agent (cisapride). 388 68

The aims of our study were to: determine the effect of metoclopramide parenterally and orally on delayed gastric emptying of a radionuclide test meal in symptomatic patients with diabetic gastroparesis not explained by ulceration or other mechanical problems; and evaluate in a double-blind crossover fashion the efficacy of metoclopramide in relieving the symptoms of diabetic gastroparesis. Thirteen patients with subjective evidence of gastric stasis had delayed gastric emptying of an isotope-labeled semisolid meal which was significantly accelerated (p less than 0.05) after 10 mg of metoclopramide parenterally. Patients then received metoclopramide 10 mg and placebo before meals and prior to retiring for 3 weeks in a randomized double-blind crossover design. During metoclopramide therapy nausea, vomiting, anorexia, fullness, and bloating were significantly (p less than 0.05) ameliorated compared to placebo with an overall mean symptom reduction of 52.6%. Gastric emptying studies after completion of the trial is seven patients, subjectively improved and receiving open-labeled metoclopramide, showed significantly less gastric retention. Individual improvements in gastric emptying after parenteral or oral metoclopramide, however, could not be correlated with symptom change during the treatment trial. We conclude that metoclopramide is an important therapeutic adjunct in the management of diabetic gastroparesis and its therapeutic effects are mediated through its prokinetic properties as well as centrally mediated antiemetic actions.
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PMID:Effect of metoclopramide in diabetic gastroparesis. 388 97

Metoclopramide tablets were compared with placebo in the treatment of gastrointestinal symptoms in 40 patients with diabetic gastroparesis. Results of a 3-wk double-blind study indicate that metoclopramide at a dosage of one 10-mg tablet four times daily reduced nausea, vomiting, fullness, and early satiety and improved meal tolerance better than placebo. Statistically significant differences were noted for nausea and postprandial fullness. Mean gastric emptying assessed by radionuclide scintigraphy was significantly improved in the metoclopramide-treated group when compared with their baseline result. Metoclopramide is an effective agent for improving the upper gastrointestinal motor function in diabetic patients with gastroparesis.
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PMID:A multicenter placebo-controlled clinical trial of oral metoclopramide in diabetic gastroparesis. 640 Jul 7

Five otherwise healthy young adults with a syndrome of recurrent intermittent gastric atony have been described. Symptomatic periods characterized by severe nausea, early satiety, and abdominal bloating alternated with asymptomatic intervals. During symptomatic phases upper gastrointestinal barium contrast radiographs demonstrated gastric dilatation with atony but without obstruction. At other times, the symptoms would disappear, and gastric size, motility, and emptying would appear normal. Upper gastrointestinal endoscopy confirmed gastric atony and showed no mucosal abnormalities or gastric outlet obstruction. No pathogenic factors were detected, and the gastroparesis was unassociated with any motility disorder of the esophagus, small bowel, or colon. Thus, it differed from other recognized forms of visceral pseudoobstruction. Because of failed medical treatment, four patients were treated with antrectomy, gastrojejunostomy, and truncal vagotomy to allow passive emptying of the stomach by gravity. All four surgically treated patients improved greatly. Idiopathic intermittent gastroparesis is a distinct clinical syndrome that can be successfully treated by surgical means in severe cases.
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PMID:Idiopathic intermittent gastroparesis and its surgical alleviation. 647 35

During a 2 year period, 83 patients with gastric motility problems were evaluated using radionuclide imaging. The patients presented with epigastric distress, postprandial fullness, pain, nausea, vomiting, and diarrhea; signs and symptoms suggestive of either gastroparesis or gastric outlet obstruction. Upper gastrointestinal series or endoscopy, or both, demonstrated no mechanical obstruction. After oral administration of a 300 g meal labeled with 600 muCi of technetium-99m sulfur colloid, a gastric emptying study consisting of serial images and data acquisition was performed. Of the patients studied, 52 had had peptic ulcer surgery, 17 were suspected of having gastroesophageal reflux, 8 were diabetic and suspected of having visceral enteropathy, and 6 had a history of irritable bowel syndrome. The normal mean gastric half emptying time was 77 +/- 16 minutes. Of the patients who had had gastric surgery, 90.4 percent had abnormal emptying: 69.2 percent had delayed gastric emptying and 21.2 percent had rapid gastric emptying time; 9.6 percent had normal emptying time. Of the gastroesophageal reflux group, all but two had normal gastric emptying time; 65 percent demonstrated gastroesophageal reflux within 15 minutes. Two of the patients with irritable bowel syndrome had prolonged emptying; the rest had normal emptying. All diabetic patients with gastroparesis had prolonged gastric emptying time, and all responded favorably to metoclopramide. Of the patients who previously had peptic ulcer surgery and had prolonged emptying time, 72 percent also responded favorably to metoclopramide. We conclude that radionuclide gastric imaging is a useful diagnostic test for the measurement of gastric emptying in patients with a variety of gastrointestinal motility disorders and may be helpful in assessing medical therapy and selecting those who may be candidates for surgery.
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PMID:Assessment of gastric motility using meal labeled with technetium-99m sulfur colloid. 665 Jul 70

Ten patients with diabetic gastroparesis were selected for a randomized, double-blind, controlled trial of metoclopramide. Each patient had longstanding insulin-requiring diabetes mellitus and symptoms of gastric stasis. The patients were evaluated for the symptoms of gastric stasis and radionucleotide gastric emptying was measured before the patients entered the study and after they were given either metoclopramide or placebo treatment. Metoclopramide, 10 mg orally, stimulated an increase in the rate of gastric emptying (56.8% +/- 7.4%) in contrast to the response to placebo (37.6% +/- 7.7%) (p less than 0.01). The overall symptoms and symptoms of vomiting were markedly reduced during metoclopramide treatment in contrast to those during placebo treatment. Before the study five patients were constipated (less than three bowel movements per week); during metoclopramide treatment the patients' bowel habits were improved. There was a poor correlation between improved gastric emptying and decreased symptoms. Metoclopramide may improve symptoms of diabetic gastric stasis through two mechanisms: its peripheral effect on gastric smooth muscle, which increases gastric emptying; and its central effects on the chemoreceptor vomiting zone, which decrease nausea.
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PMID:Metoclopramide to treat gastroparesis due to diabetes mellitus: a double-blind, controlled trial. 706 59

Fifty-five patients with delayed gastric emptying and the symptoms of nausea, vomiting, postprandial bloating and early satiety were treated with metoclopramide. Obstruction was excluded by upper endoscopy and standard upper gastrointestinal series. None were on medication known to retard gastric emptying. All patients had an abnormal barium burger radiologic study. Twenty-one patients had had previous vagotomy and drainage procedure, five had diabetic gastroparesis and 29 had idiopathic delayed gastric emptying. Metoclopramide significantly decreased the symptom scores of the surgical and idiopathic patients. When all patients were analyzed together, there was a significant improvement in both the metoclopramide and placebo treated patients. When, however, the improvement on metoclopramide was compared to the improvement on placebo, there was a significant metoclopramide effect beyond the placebo effect. Thus, metoclopramide is an effective agent in treating the symptom-complex of patients with delayed gastric emptying.
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PMID:Metoclopramide therapy in fifty-five patients with delayed gastric emptying. 746 58

About one-half of patients with insulin- or non-insulin-dependent diabetes have delayed gastric emptying (diabetic gastroparesis). Some of them complain of epigastric pain, nausea, vomiting or postprandial fullness (diabetic dyspepsia), although only a minority are severely symptomatic. Diabetic gastroparesis is clinically relevant not only by virtue of the symptoms induced but also because it may contribute to inadequate glycaemic control and impaired absorption of orally administered drugs. Recent data suggest that abnormal blood glucose control, not only autonomic neuropathy, contribute to the pathogenesis of disordered gastric motility. In most cases diabetic gastroparesis is diagnosed clinically in the absence of demonstrable lesions of the upper gastrointestinal tract. To evaluate gastric emptying, scintigraphy is the 'gold standard'. Gastrokinetic drugs are of help in the treatment of gastroparesis: erythromycin is the first choice in acute presentations and cisapride for chronic symptoms. New macrolides with prokinetic action and devoid of antibacterial properties are very promising and should add another pharmacologic approach to control dyspepsia and gastroparesis in diabetic patients in the future.
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PMID:Gastroparesis and dyspepsia in patients with diabetes mellitus. 749 57

Patients are often referred for evaluation of a wide range of GI complaints including dysphagia, abdominal pain, bloating, nausea, constipation or diarrhoea. Many are diagnosed with 'functional' disease when endoscopy or conventional radiological studies fail to identify an anatomic cause for the patient's symptoms. In such cases nuclear medicine offers non-invasive methods for objectively demonstrating disease involving different areas of the gastrointestinal tract. Increasingly scintigraphy is playing a primary role in the evaluation of patients with suspected acute cholecystitis, active gastrointestinal bleeding, gastroparesis, and small and large bowel motility disorders. In addition, it supplements other studies when results are inconclusive in diagnosing oesophageal dysmotility, gastro-oesophageal reflux, acalculous cholecystitis, and postoperative complications of gastrointestinal surgery.
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PMID:Current applicability of scintigraphic methods in gastroenterology. 777 16


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